Abstract
Objectives The quality and safety of drug therapy in primary care are global concerns. The Pharmacist and Data-Driven Quality Improvement in Primary Care (P-DQIP) intervention aims to improve prescribing safety via an informatics tool, which facilitates proactive management of drug therapy risks (DTRs) by health-board employed pharmacists with established roles in general practices. Study objectives were (1) to identify and prioritise factors that could influence P-DQIP implementation from the perspective of practice pharmacists and (2) to identify potentially effective, acceptable and feasible strategies to support P-DQIP implementation.
Design Semistructured face-to-face interviews using a Theoretical Domains Framework informed topic guide. The framework method was used for data analysis. Identified implementation factors were prioritised for intervention based on research team consensus. Candidate intervention functions, behavioural change techniques (BCTs) and policies targeting these were identified from the behavioural change wheel. The final intervention content and modes of delivery were agreed with local senior pharmacists.
Setting General practices from three Health and Social Care Partnerships in National Health Service (NHS) Tayside.
Participants 14 NHS employed practice pharmacists.
Results Identified implementation factors were linked to thirteen theoretical domains (all except intentions) and six (skill, memory/attention/decision making, behavioural regulation, reinforcement, environmental context/resources, social influences) were prioritised. Three intervention functions (training, enablement and environmental restructuring) were relevant and were served by two policy categories (guidelines, communication/marketing) and eight BCTs (instructions on how to perform a behaviour, problem solving, action planning, prompt/cues, goal setting, self-monitoring, feedback and restructuring the social environment). Intervention components encompass an informatics tool, written educational material, a workshop for pharmacists, promotional activities and small financial incentives.
Conclusions This study explored pharmacists’ perceptions of implementation factors which could influence management of DTRs in general practices to inform implementation of P-DQIP, which will initially be implemented in one Scottish health board with parallel evaluation of effectiveness and implementation.
Design Semistructured face-to-face interviews using a Theoretical Domains Framework informed topic guide. The framework method was used for data analysis. Identified implementation factors were prioritised for intervention based on research team consensus. Candidate intervention functions, behavioural change techniques (BCTs) and policies targeting these were identified from the behavioural change wheel. The final intervention content and modes of delivery were agreed with local senior pharmacists.
Setting General practices from three Health and Social Care Partnerships in National Health Service (NHS) Tayside.
Participants 14 NHS employed practice pharmacists.
Results Identified implementation factors were linked to thirteen theoretical domains (all except intentions) and six (skill, memory/attention/decision making, behavioural regulation, reinforcement, environmental context/resources, social influences) were prioritised. Three intervention functions (training, enablement and environmental restructuring) were relevant and were served by two policy categories (guidelines, communication/marketing) and eight BCTs (instructions on how to perform a behaviour, problem solving, action planning, prompt/cues, goal setting, self-monitoring, feedback and restructuring the social environment). Intervention components encompass an informatics tool, written educational material, a workshop for pharmacists, promotional activities and small financial incentives.
Conclusions This study explored pharmacists’ perceptions of implementation factors which could influence management of DTRs in general practices to inform implementation of P-DQIP, which will initially be implemented in one Scottish health board with parallel evaluation of effectiveness and implementation.
Original language | English |
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Article number | e033574 |
Number of pages | 16 |
Journal | BMJ Open |
Volume | 10 |
Issue number | 2 |
Early online date | 29 Feb 2020 |
DOIs | |
Publication status | Published - Feb 2020 |
Bibliographical note
The listed order of the authors represents extent of contribution. The authors would like to thank the participating practice pharmacists, the three senior pharmacists who assisted in specifying the implementation strategy, and Suzanne Grant, who helped develop the topic guide and advised on data-analysis.This work was supported by the Scottish Improvement Science Collaborating Centre (SISCC) which is funded by the Scottish Funding Council (SFC), Chief Scientist’s Office, NHS Education for Scotland and The Health Foundation with in kind contributions from participating partner universities and health boards. Grant number 242343290.
Keywords
- quality improvement
- behaviour change wheel
- theoretical domains framework
- behaviour change technique
- polypharmacy review
- prescribing safely
- behavioural change wheel
- behavioural change techniques
- prescribing safety
- TRIAL